Types of Cough Medicines 101

Marion Sereti

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October 25, 2022
CoughPro is not a medical product. It is a wellness app intended only for users to obtain a better understanding of their cough. It is not intended to diagnose, monitor, or treat any illness.

We at Hyfe, Inc., are a company devoted to working on tools to better understand the importance of cough. It is Hyfe’s intention in the future to seek regulatory approval for medical products that analyze cough in order that they may be used to diagnose, monitor, and facilitate better treatment of respiratory illnesses.

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Everyone coughs; it is the most effective way for your body to eliminate allergens, irritants, mucus, pollen, and phlegm from the respiratory system. Coughs tend to go away on their own after a few days, but if one continues to stick around after a week or two, you might need some help to get rid of it. Here's an overview of various types of cough medicine you should know about.

Suppressants/Antitussives

Cough suppressants, as the name suggests, are medicines that control and reduce coughing; they are also known as antitussives. 

Antitussives are thought to work by blocking/disrupting the cough reflex by directly working on the central nervous system1, although the specific location and mechanism of their action varies depending on the type of drug and some affect the nervous system in more than one way2. These medicines relieve the cough symptom but do not treat the cause of the cough or speed up recovery. 

Antitussives are only recommended for dry, irritating coughs that do not involve mucus production. Using cough suppressants for treating a cough related to smoking, long-term bronchial problems, or acute infection is not advised because suppressing these productive (mucus-producing) coughs may be detrimental as they are the mechanism by which the body rids itself of the infected material. 

Antitussive Drugs

Most suppressants are derived from opioids3 (a class of pain-relieving drugs), and they include:

  • Dextromethorphan – a commonly used antitussive known under the brand names Babee Cof, Buckleys Mixture and Triaminic Long Acting Cough 
  • Pholcodine – also known as Abenol and Day Nurse 
  • Codeine – usually used as a pain reliever, it also has antitussive properties

Find out more on cough syrups here.

Natural/Alternative Medicine Cough Suppressants

Peppermint

Peppermint leaves

Peppermint contains mentho4l, which soothes nerves in the throat made sore by coughing. As a result, it can help ease discomfort and reduce the desire to cough. Additionally, it has been found to have antiviral and antibacterial properties5, which help your body fight any infection. 

Natural cough medicines use: 

  • You can take peppermint by mixing it with tea or sucking on peppermint lozenges. 
  • You can even use it in the form of essential oils, which can be directly applied onto your neck and chest or put in a humidifier for inhaling. Essential oils must not be ingested.

Marshmallow

You are probably thinking about the soft, sweet candy. Unfortunately, marshmallows can’t treat a cough! What we mean is the plant marshmallow, Althaea officinalis6, a perennial that blooms in the summer. People have known and used its roots and leaves to suppress coughs and treat sore throats for a long time. 

Studies have shown that7 this herb is one of the best cough medicines. It contains mucilage that soothes irritation and coats the throat. Thanks to its antibacterial properties, it can prevent your cough from coming back.

Natural cough medicines use: 

  • You can either take it through capsules or have it as tea; warm tea is an excellent beverage itself for soothing your cough8

Expectorants

An expectorant is a cough medicine for clearing mucus (phlegm) from your airways. 

Expectorants work by lubricating your airway, which helps thin the secretions in your airway and loosens up mucus. Through this, expectorants make your cough more productive. This makes it easier for you to cough up mucus effectively and clear your throat.

Expectorant Medication

A great example is guaifenesin9 – this is the most commonly used expectorant and the only expectorant approved by the U.S. Food and Drug Administration (FDA) to be sold over the counter. 

The most common brand names are Mucinex® and Robitussin®. 

It is also found as an ingredient in many common cough, cold, and flu medications.

Natural/Alternative Medicine Expectorant

Natural expectorants are another option if you're trying to loosen up mucus and relieve chest congestion without drugs. Natural expectorants include:

Bromelain

Bromelain is an enzyme distilled from pineapple stems10. It can loosen the mucus in the back of your throat and suppress coughs. 

Natural cough medicines use

  • Have a full glass or a slice of pineapple three times a day to have the maximum benefits from pineapple’s bromelain
  • Mix pinapple extract and honey to make a soothing drink11

Thyme

Thyme can help treat a handful of different respiratory diseases. When the essence extracted from thyme leaves is mixed with the same from ivy, the mixture becomes a good cough medicine12 that can also treat short-term bronchitis.

This is likely because plant's leaves contain flavonoids, which are compounds that can relax the throat muscles that, cause coughing, and ease inflammation. 

Natural cough medicines use: 

  • Mix 1 cup of boiling water and two teaspoons of crushed thyme leaves to make thyme tea. 
  • Try rubbing thyme essential oil to rub it onto your neck and chest for a more immediate effect. Never ingest essential oils.

Others plants potentially with expectorant effects include: 

  • Aloe vera – it is used in many herbal medicine traditions as an expectorant
  • Eucalyptus13 – it can reduce lung inflammation, making it easier for the mucus to move
  • Ginger14 – similar to eucalyptus
  • Ivy extract15

Additionally, simply staying hydrated will help your body continue producing the mucus to cough out the infection.

Decongestants

A decongestant is a type of cough medicine designed to constrict the nasal blood vessels and reduce the size of the inflamed passages in the nasal cavity. Colds or severe allergic reactions often bring on this inflammation.

Decongestants work by narrowing the small blood vessels in your nose, throat, and sinuses, reducing nasal secretions and the thickness of the lining of your nose. Hence, the medication improves the blocked-up feeling.

They are available as saline drops, nasal sprays, tablets, capsules, and syrup.

Decongestant Medication

Almost all decongestant medications are based around epinephrine or pseudoepinephrine. 

Epinephrine is most well known for being used to treat anaphylaxis, a severe allergic reaction that poses a serious risk to one's life. It does this by interacting with the body’s central nervous system to reduce its immune and allergy response by stimulating the fight-or-flight response. Pseudoepinephrine is a different chemical with a similar effect.

Part of this effect is the constriction of blood vessels. This is what gives epinephrine and pseudoepineprhine their decongestant ability – the blood vessels in the nose become temporarily smaller, meaning the nasal cavity can be wider and allow more air through.

Natural/Alternative Medicine Decongestants

Additionally, there are several natural ways to treat nasal congestion. For example:

Salt and Water

Though this may sound simple, it's one of the best natural decongestants out there, mainly because it's easy to make. 

You’ve just got to spray it up your nose.

This is nasal irrigation or saline irrigation16. It removes excess mucus from your nose and helps soften and wash out crusts. This makes it easier to breathe by clearing out your nasal cavity. It also moisturises the inside of your nose, which will additionally help decongest it if it is swollen due to being dry.

Natural cough medicines use:

  1. Mix one teaspoon of salt and half a teaspoon of baking soda in 570 ml of boiled and cooled water
  2. Put this into a freshly cleaned neti pot/nasal irrigation pot
  3. Bend over a sink or other container and slightly tilt your head to around 45°
  4. Breathe through your mouth and don’t speak during the nasal irrigation
  5. Pour half of the salt water into the upper nostril; it should flow out the lower nostril
  6. Tilt your head the other way and repeat for the second nostril
  7. Breathe in through your mouth and out through your nose to make sure it’s empty of water

Hot Drinks

When you are feeling under the weather, many different hot drinks can be soothing and make you feel better. A good cup of tea or a lemon and ginger infusion is calming and comforting. Additionally, hot drinks also work as natural decongestants17

Turmeric

Curcumin, one of the chemicals naturally present in turmeric, is an anti-inflammatory. It works as a decongestant by reducing the inflammation in the nose18, opening up the nasal cavity to better air flow.

Natural cough medicine use:

  • Try a hot turmeric infusion for the anti-inflammatory effect of turmeric with the added benefit of a hot drink
  • Turmeric can also be taken as a supplement or added to dishes

Steam Inhalation

Simple steam19 can help loosen the mucus and crust in your nose, which can make it easier to breathe. This is similar to nasal irrigation, but you don’t need to pour hot water into your nose.

Natural cough medicine use:

  • Boil some water and pour it into a bowl, then lean over, place a towel over your head and the bowl and spend some time breathing the steam in
  • Go to a sauna

Antihistamines

Antihistamines are cough medicines used to dry up a runny nose or reduce sneezing caused by allergies. Examples are brompheniramine, chlorphenamine, diphenhydramine, doxylamine, promethazine, or triprolidine.

Antihistamines reduce your body’s allergic reactions of a runny nose and watery eyes by blocking the receptors of the histamine chemical, i.e. the chemical your body releases when triggered by an allergy. 

Certain types of antihistamines can relieve a chronic cough20 – if you have a long-term cough, consider talking to your doctor about whether antihistamines may relieve your cough.

Topical Cough Medicines

Topical cough medicines are ointments made of ingredients containing camphor, menthol, or eucalyptus oil. They are often rubbed on the chest, throat, or back to get relief from cough and cold. Their strong-smelling vapors may ease your cough and open up your stuffy head.

The most widely known example of a topical cough medicine is the Vicks VaporRub21.

While there is not enough evidence to prove the effectiveness of these medicines some evidence suggests that it helps improve sleep22.

You can get also these topical medicines in liquid form to use with a vaporizer (a gadget that makes steam you can breathe in). Menthol is also available in lozenges and compressed tablets.

Combination Medicine

Combination medicine includes other products to ease other symptoms. Therefore, you can choose a cough medicine that matches all of your symptoms.

For instance, many over-the-counter treatments mix the following:

  • A suppressant and expectorant with medicines for other symptoms 
  • An Antihistamine and decongestant to treat nasal congestion (stuffy nose), sneezing, and runny nose caused by colds and allergies such as hay fever
  • All this could also include a pain reliever 

The blend can be a great thing on the off chance you have a run of cold side effects, like body throbs, pain, and congestion.

Prescription vs. OTC Cough Medicine

Medicines are designed to be used in the diagnosis, treatment, alleviation, or prevention of disease. Perhaps your biggest worry is how to acquire the medication you need. 

Suppose you have ever taken a few laps to a nearby pharmacy. In that case, you will realize that they sometimes ask you, ”Do you have a prescription?” and sometimes they just give a particular medicine to you without further questioning.

So you can be more informed the next time, here are the primary distinctions between prescription medications and over-the-counter medicines.

Prescription Medicine

Prescription medicine can only be given to a patient on the written orders of a licensed healthcare provider at a pharmacy. This type of medication is authorized for and designed for one person only.

  • The FDA regulates prescription medicines through the New Drug Application (NDA) procedure (this is the official procedure a drug sponsor follows to request that the FDA give a new drug permission to be marketed in the United States).

Over-The-Counter (OTC) medicines

Over-the-counter (OTC) medicines can be sold directly to people without a prescription, also referred to as nonprescription medicine.

OTC medicines are bought at stores off the shelf.OTC medicines are regulated by the FDA using OTC Drug monographs. Monographs describe permissible components, doses, formulations, and labeling.

  • Overall, OTC medicines are considered safe and effective23 when you adhere to the instructions on the label and as advised by your healthcare provider.

Cough Medicine Safety

Concerns24 about the safety, efficacy and use25 of over-the-counter cough and cold medications have led to a recent U.S. Food and Drug Administration public health advisory against administering them to children under two years of age. 

While OTC medicines are generally safe, children should only take cough syrups with no active ingredients26 - for example, glycerin, honey, and lemon. Check with your health care provider for remedies for specific symptoms.

Codeine is banned for all children under the age of 12 and teenagers between the ages of 12–18 who have additional risk factors that could make them more susceptible to its potential breathing suppression effects

Children under 16 should not use aspirin unless a doctor has specifically prescribed it.

How To Safely Use Cough Medicines  

Always read the label carefully – upon purchase of an OTC medicine, the FDA advises27 reading the label carefully so that you understand how to take it, typical side effects, and any warnings you need to be aware of. 

Don't just grab any bottle with "cough" written on it. 

  • Below is a summary of what to look out for on the label:Product name 
  • Active ingredients – This refers to therapeutic substances. Verify the ingredient are appropriate for the person who will take it.
  • Purpose – This refers to product classification. Is it an expectorant, antihistamine, antacid, or suppressant? Ensure that you are receiving what you require. 
  • Warnings – This includes when you should not use the product, when to stop, when to visit a doctor, and any potential adverse effects.
  • Uses – This refers to the symptoms or diseases the medication will treat or prevent.
  • Dosage/directions – How much to take or use, how to take or use it, and for how long. High doses of cough medicine have the potential to be fatal or result in severe side effects like brain damage or seizures. Always take the correct dosage.
  • Other information – This includes storage information.
  • Inactive ingredients – includes additives such as binders, colors, and flavors. Check if there are any that you/the patient are allergice too, such as gluten or tartrazine (E102).

How to Safely Combine Cough Medicine With Other Medicines

Always check with your pharmacist when buying any cough medications from the chemist or supermarket to see if they are safe to take with any other medications you'll be taking.

You can also use the Interaction Checker on drugs.com.

Several cough medications contain the same active ingredients. Imagine a particular drug has pain relievers, so if you are taking these medicines and are also taking a separate cough medicine that contains the same pain reliever, you could be getting a dangerous amount of the pain reliever.

In fact, the United States FDA warns28 against combining opioid29 pain or cough medicines with benzodiazepines as they pose serious risks and death.

So, If you are taking any other medicines or are unsure if you should take cough medicine, check with your pharmacist.

How to Safely Store Cough Medicines

  • You should keep all medications up and out of young children's reach and sight.
  • Store medicines in a cool, dry area to avoid losing their effectiveness before expiration.
  • You should not keep medicines in bathrooms or cabinets because they are frequently warm and damp, which can affect the chemical composition of the medication or cause it to develop mold.

Conclusion

Many viral coughs are best treated by taking good care of your health and preventing yourself from developing a cough through increasing fluid intake and exposing the airways to humidity. If you do develop a cough, using several natural solutions can offer relief, especially when used alongside medication. Over-the-counter (OTC) medications can assist in temporarily relieving symptoms while your body fights the infection. 

If symptoms persist, always seek medical help.

References
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  2. Nosalova, G., Mokry, J., & Franova, S. (2006). Pharmacological modulation of cough reflex. Advances in Phytomedicine, 2, 87–110. https://doi.org/10.1016/S1572-557X(05)02006-4[]
  3. Nosalova, G., Mokry, J., & Franova, S. (2006). Pharmacological modulation of cough reflex. Advances in Phytomedicine, 2, 87–110. https://doi.org/10.1016/S1572-557X(05)02006-4[]
  4. Wise, P. M., Breslin, P. A., & Dalton, P. (2012). Sweet taste and menthol increase cough reflex thresholds. Pulmonary pharmacology & therapeutics, 25(3), 236–241. https://doi.org/10.1016/j.pupt.2012.03.005[]
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  6. Althaea officinalis. (2022, April 17). In Wikipedia. https://en.wikipedia.org/w/index.php?title=Althaea_officinalis&oldid=1083137340 []
  7. Banaee, M., Soleimany, V., & Nematdoost Haghi, B. (2017). Therapeutic effects of marshmallow (Althaea officinalis L.) extract on plasma biochemical parameters of common carp infected with Aeromonas hydrophila. Veterinary research forum : an international quarterly journal, 8(2), 145–153. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5524553/ []
  8. Sanu, A., & Eccles, R. (2008). The effects of a hot drink on nasal airflow and symptoms of common cold and flu. Rhinology, 46(4), 271–275. https://pubmed.ncbi.nlm.nih.gov/19145994/[]
  9. National Library of Medicine. (n.d.) Guaifenesin. In MedlinePlus. Retrieved September 18 2022, from https://medlineplus.gov/druginfo/meds/a682494.html []
  10. Chakraborty, A. J., Mitra, S., Tallei, T.E., Tareq, A.M., Nainu, F., Cicia, D., Dhama, K., Emran, T.B., Simal-Gandara, J., & Capasso, R. (2021) Bromelain a Potential Bioactive Compound: A Comprehensive Overview from a Pharmacological Perspective. Life, 11(4), 317–343. https://doi.org/10.3390/life11040317 []
  11. Peixoto, D. M., Rizzo, J. A., Schor, D., Silva, A. R., Oliveira, D. C., Solé, D., & Sarinho, E. (2016). Use of honey associated with Ananas comosus (Bromelin) in the treatment of acute irritative cough. Uso do mel de abelha associado ao Ananas comosus (Bromelin) no tratamento da tosse irritativa aguda. Revista paulista de pediatria : orgao oficial da Sociedade de Pediatria de Sao Paulo, 34(4), 412–417. https://doi.org/10.1016/j.rpped.2016.03.006 []
  12. Kemmerich, B., Eberhardt, R., & Stammer, H. (2006). Efficacy and tolerability of a fluid extract combination of thyme herb and ivy leaves and matched placebo in adults suffering from acute bronchitis with productive cough. A prospective, double-blind, placebo-controlled clinical trial. Arzneimittel-Forschung, 56(9), 652–660. https://doi.org/10.1055/s-0031-1296767 []
  13. Lin, W., Jianbo, S., Wanzhong, L., Yanna, L., Weiwei, S., Gang, W., & Chunzhen, Z. (2017). Protective effect of eucalyptus oil on pulmonary destruction and inflammation in chronic obstructive pulmonary disease (COPD) in rats. Journal of Medicinal Plants Research, 11(6), 129–136. https://doi.org/10.5897/jmpr2015.5910  []
  14. Mashhadi, N. S., Ghiasvand, R., Askari, G., Hariri, M., Darvishi, L., & Mofid, M. R. (2013). Anti-oxidative and anti-inflammatory effects of ginger in health and physical activity: review of current evidence. International journal of preventive medicine, 4(Suppl 1), S36–S42. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3665023/[]
  15. Kemmerich, B., Eberhardt, R., & Stammer, H. (2006). Efficacy and tolerability of a fluid extract combination of thyme herb and ivy leaves and matched placebo in adults suffering from acute bronchitis with productive cough. A prospective, double-blind, placebo-controlled clinical trial. Arzneimittel-Forschung, 56(9), 652–660. https://doi.org/10.1055/s-0031-1296767 []
  16. King, D. (2019). What role for saline nasal irrigation? Drug and Therapeutics Bulletin, 57(4), 56–59. https://doi.org/10.1136/dtb.2018.000023[]
  17. Sanu, A., & Eccles, R. (2008). The effects of a hot drink on nasal airflow and symptoms of common cold and flu. Rhinology, 46(4), 271–275. https://pubmed.ncbi.nlm.nih.gov/19145994/[]
  18. Wu, S., & Xiao, D. (2016). Effect of curcumin on nasal symptoms and airflow in patients with perennial allergic rhinitis. Annals of Allergy, Asthma & Immunology, 117(6), 697–702.e1. https://doi.org/10.1016/j.anai.2016.09.427[]
  19. Vathanophas, V., Pattamakajonpong, P., Assanasen, P., & Suwanwech, T. (2021). The effect of steam inhalation on nasal obstruction in patients with allergic rhinitis. Asian Pacific Journal of Allergy and Immunology, 39(4), 304–308. https://doi.org/10.12932/ap-090818-0393[]
  20. Bolser, D. C. (2007). Older-Generation Antihistamines and Cough Due to Upper Airway Cough Syndrome (UACS): Efficacy and Mechanism. Lung, 186(S1), 74–77. https://doi.org/10.1007/s00408-007-9033-y   []
  21. Santhi, N., Ramsey, D., Phillipson, G., Hull, D., Revell, V. L., & Dijk, D.J. (2017). Efficacy of a Topical Aromatic Rub (Vicks VapoRubⓇ) on Effects on Self-Reported and Actigraphically Assessed Aspects of Sleep in Common Cold Patients. Open Journal of Respiratory Diseases, 7(2), 83–101. https://doi.org/10.4236/ojrd.2017.72009[]
  22. Paul, I. M., Beiler, J. S., King, T. S., Clapp, E. R., Vallati, J., & Berlin, C. M., Jr (2010). Vapor rub, petrolatum, and no treatment for children with nocturnal cough and cold symptoms. Pediatrics, 126(6), 1092–1099. https://doi.org/10.1542/peds.2010-1601[]
  23. U.S. Food & Drug Administration (2018). Understanding Over-the-Counter Medicines. United States Government. https://www.fda.gov/drugs/buying-using-medicine-safely/understanding-over-counter-medicines[]
  24. Lokker, N., Sanders, L., Perrin, E. M., Kumar, D., Finkle, J., Franco, V., Choi, L., Johnston, P. E., & Rothman, R. L. (2009). Parental misinterpretations of over-the-counter pediatric cough and cold medication labels. Pediatrics, 123(6), 1464–1471. https://doi.org/10.1542/peds.2008-0854[]
  25. Lam, S., Homme, J., Avarello, J., Heins, A., Pauze, D., Mace, S., Dietrich, A., Stoner, M., Chumpitazi, C. E., & Saidinejad, M. (2021). Use of antitussive medications in acute cough in young children. Journal of the American College of Emergency Physicians open, 2(3), e12467. https://doi.org/10.1002/emp2.12467[]
  26. U.S. Food & Drug Administration (2021). Should You Give Kids Medicine for Coughs and Colds? United States Government.https://www.fda.gov/consumers/consumer-updates/should-you-give-kids-medicine-coughs-and-colds []
  27. U.S. Food & Drug Administration (2013). Over-the-Counter Medicines: What's Right for You?. United States Government. https://www.fda.gov/drugs/choosing-right-over-counter-medicine-otcs/over-counter-medicines-whats-right-you[]
  28. U.S. Food & Drug Administration (2017). FDA Drug Safety Communication: FDA warns about serious risks and death when combining opioid pain or cough medicines with benzodiazepines; requires its strongest warning. United States Government. https://www.fda.gov/drugs/drug-safety-and-availability/fda-drug-safety-communication-fda-warns-about-serious-risks-and-death-when-combining-opioid-pain-or[]
  29. U.S. Food & Drug Administration (2021). Opioid Medications. United States Government. https://www.fda.gov/drugs/information-drug-class/opioid-medications []

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